Longitudinal changes in the ganglion cell complex thickness in acute central serous chorioretinopathy using spectral-domain optical coherence tomography.

In this retrospective longitudinal cohort study, we investigated the temporal changes in the peripapillary retinal nerve fiber layer (pRNFL) and inner retinal thickness in patients with acute central serous chorioretinopathy (CSC) using spectral-domain optical coherence tomography (SD-OCT). We followed up with these patients for 6 months, and during this period, the thickness of the pRNFL and the ganglion cell complex (GCC) in CSC patients were compared with the eyes of normal healthy individuals. The study also examined the correlation between the pRNFL thickness, GCC thickness, and visual acuity. The research sample consisted of 67 patients (43 male and 24 female) with an average age of 49.72 ± 9.87 years. The initial findings showed no significant differences in the pRNFL and GCC thickness between the study and fellow eye, study and normal healthy eyes, and fellow and normal healthy eyes. There was no significant difference in the pRNFL and GCC thickness when comparing the study eye with the fellow eye for 6 months. In the study eye, no significant difference was observed when comparing the initial GCC and pRNFL thickness with those at 1, 3, and 6 months. Visual acuity improved significantly from 0.18 ± 0.23 logMAR to 0.04 ± 0.06 logMAR (p < 0.001). The GCC and pRNFL thickness did not significantly affect visual acuity. In conclusion, acute CSC patients did not show significant changes in the pRNFL and inner retinal thickness, suggesting that the GCC and pRNFL do not substantially influence the short-term visual prognosis in these patients.

Classifying central serous chorioretinopathy subtypes with a deep neural network using optical coherence tomography images: a cross-sectional study.

Central serous chorioretinopathy (CSC) is the fourth most common retinopathy and can reduce quality of life. CSC is assessed using optical coherence tomography (OCT), but deep learning systems have not been used to classify CSC subtypes. This study aimed to build a deep learning system model to distinguish CSC subtypes using a convolutional neural network (CNN). We enrolled 435 patients with CSC from a single tertiary center between January 2015 and January 2020. Data from spectral domain OCT (SD-OCT) images of the patients were analyzed using a deep CNN. Five-fold cross-validation was employed to evaluate the model's ability to discriminate acute, non-resolving, inactive, and chronic atrophic CSC. We compared the performances of the proposed model, Resnet-50, Inception-V3, and eight ophthalmologists. Overall, 3209 SD-OCT images were included. The proposed model showed an average cross-validation accuracy of 70.0% (95% confidence interval [CI], 0.676-0.718) and the highest test accuracy was 73.5%. Additional evaluation in an independent set of 104 patients demonstrated the reliable performance of the proposed model (accuracy: 76.8%). Our model could classify CSC subtypes with high accuracy. Thus, automated deep learning systems could be useful in the classification and management of CSC.

Comparison of the effect of air tamponade versus no tamponade after pars plana vitrectomy for idiopathic epiretinal membrane.

This study aimed to compare the surgical outcomes of pars plana vitrectomy (PPV) with and without air tamponade in patients with idiopathic epiretinal membrane (iERM). We prospectively enrolled 145 patients with iERM who underwent a 25-gauge transconjunctival sutureless PPV. Patients were assigned to either the air tamponade (air) group (79 eyes) or balanced salt solution (BSS; no tamponade) group (66 eyes). The central macular thickness (CMT), peripapillary retinal nerve fiber layer (pRNFL) thickness, and best-corrected visual acuity (BCVA) were compared for two years. At baseline, there were no significant differences between the two groups. CMT and BCVA were not significantly different between the groups for 2 years. However, the air group had a significantly lower thickness in the superior temporal pRNFL sector at 1 month (p = 0.01) and in the inferior temporal and superior temporal pRNFL sectors at 3 months (p = 0.02 for both). There were no significant differences between both groups in all the pRNFL sectors from 6 months to 2 years. The outcomes of PPV with air tamponade and that with no tamponade appear to be equivalent. This shows that air tamponade may not be an imperative procedure for iERM surgery and has no additional benefit.

Effect of intravitreal ranibizumab and aflibercept injections on retinal nerve fiber layer thickness.

The purpose is to evaluate the effects of multiple intravitreal ranibizumab (IVR) and aflibercept (IVA) injections on peripapillary retinal nerve fiber layer (RNFL) thickness in patients with exudative age-related macular degeneration (AMD). This retrospective, observational, consecutive case series study enrolled patients newly diagnosed with monocular exudative AMD from January 2014 to October 2019 who were administered IVR or IVA injections. Normal fellow eyes were included as controls. Medical records and spectral domain optical coherence tomography results were reviewed at baseline and at 3, 6, and 12 months after injection. No statistically significant differences in peripapillary RNFL thickness and intraocular pressure were observed between the treated and fellow eyes in the two groups. The global RNFL thicknesses for the treated eyes decreased significantly after 12 months compared with baseline, but no significant difference was observed in any of the six examined sectors (temporal, superior temporal, superior nasal, nasal, inferior nasal, and inferior temporal). At 12 months, the central macular thickness of the treated eyes decreased significantly. Multiple IVR and IVA injections are apparently safe considering peripapillary RNFL damage in patients with exudative AMD. The decreased RNFL thickness of the global sector was presumably due to anatomical improvement of macular lesions.

Effect of Anti-glaucoma Agents on Myopic Retinoschisis.

PURPOSE: To evaluate the effect of intraocular pressure (IOP)-lowering medications on myopic retinoschisis. METHODS: The medical records of 33 patients (36 eyes) with myopic retinoschisis associated with pathologic myopia were reviewed retrospectively. The patients were divided into two groups: the study group comprising patients undergoing treatment with anti-glaucoma medications for suspected glaucoma; the control group comprising patients who did not use any IOP lowering medications. The changes in retinoschisis in the two groups were compared using the Spectralis domain optical coherence tomography thickness map protocol. RESULTS: The study group included 18 eyes (17 patients), and the control group included 18 eyes (16 patients). There were no significant differences between the 6-month and 12-month improvement or aggravation rates of the two groups (p = 0.513 and 0.137, respectively). However, after 18 months, the aggravation rate of retinoschisis was significantly lower in the study group (p = 0.003). The improvement / aggravation rate was 58.33% / 16.67% in the study group and 0% / 57.14% in the control group. CONCLUSIONS: The use of IOP-lowering medications for more than a year may be useful for the management of retinoschisis associated with pathologic myopia.

Evaluation of the Safety of Bilateral Same-Day Intravitreal Injections of Anti-Vascular Endothelial Growth Factor Agents: Experience of a Large Korean Retina Center.

PURPOSE: To evaluate the short-term ophthalmic side effects of bilateral same-day intravitreal anti-vascular endothelial growth factor (VEGF) injections. PATIENTS AND METHODS: We retrospectively analyzed patients who received intravitreal bevacizumab, ranibizumab, and aflibercept injections in both eyes on the same day between January 2014 and June 2019. The patients were followed up for 1 day, 1 week, and 1 month after the injections. RESULTS: A total of 323 patients (646 eyes) received 1418 bilateral same-day intravitreal anti-VEGF injections. The patients' mean age was 62.47 ± 13.97 years. The most common cause of bilateral injection was age-related macular degeneration (54.80%), followed by complications due to diabetic retinopathy (35.33%), retinal vein occlusion (2.40%), and central serious chorioretinopathy (1.27%). There were 22 cases of subconjunctival hemorrhage, 17 cases of temporary elevation of intraocular pressure, and no case of endophthalmitis. Twenty-one patients showed acute intraocular inflammation after the bilateral injection. All patients showed complete improvement within 2 weeks after the injection. CONCLUSION: Bilateral same-day intravitreal anti-VEGF injection is a well-tolerated procedure on short-term follow-up. It is one of the more convenient approaches for both the patient and ophthalmologist.